Lonely Women – And Men – At the Top

This weekend marks the twentieth anniversary of the suicide death of Nirvana guitarist and front man Kurt Cobain. Cobain’s influence on music is still felt today and, unfortunately, suicide and the scourge of heroin addiction, which Cobain reportedly suffered, are more problematic than ever. The recent suicide of a bitcoin exchange firm CEO, in the wake of several high profile deaths in the financial world, highlights the dangers of isolation and stress of those “Lonely at the Top.” In a book by the same name, Dr. Thomas Joiner describes the emotional price paid by those who are often at the pinnacle of success and become so at the expense of connection with others. Joiner’s theory may also partially explain a rash of lawyer suicide deaths in Kentucky that has become a call to action for the Kentucky Bar Association’s Kentucky Lawyer Assistance Program (KYLAP). While KYLAP’s original mission was to help lawyers with drug and alcohol problems, suicide has become a recent critical charge, because substance abuse, such as heroin use, and suicide often go hand-in-hand.

In a bid to toughen anti-heroin legislation in Kentucky, State Attorney General Jack Conway told the Kentucky House Judiciary Committee recently that 123 Kentuckians died from heroin overdose in 2012. This past year, 631 Kentuckians died by suicide and, likely, many of those who died from heroin overdose were also suicides. These are both critical problems that should be addressed together.

Data from the Centers for Disease Control and the National Center for Injury Prevention and Control show that suicide death has risen nationally not just among those men “in the middle” of their lives (35 – 64 years of age), but women as well. Historically, the bulk of suicide risk has been on the ends of the age spectrum, younger and elderly people, but recent data from 1999 – 2010 show that suicide has risen 28 percent among this middle cohort of Americans. As a result, suicide has moved up the rankings for cause of death among Americans 35-64 years of age from the 10th leading cause of death in 1999 to the 4th leading cause of death. The rate for men in this cohort was three times that of women, suggesting that there is a disturbing increase in suicide among men in this age range. Researchers have pointed to three areas that need more investigation to understand their relationship with suicide risk: a “baby boomer” cohort effect, economic pressures, and prescription drug addiction, especially opioids. Others are suggesting that prevention efforts need to target what contributes to suicide risk and to be examined in the context of other adverse outcomes that share common risks. Often researchers and prevention specialists become hung up on the individual’s “intent” to kill themselves or whether a drug overdose was accidental, which implies a lack of intent. In Europe, “self-harm” is inclusive of those who deliberately or accidentally overdose and researchers examine both because the outcome is the same — death. Prevention efforts are broadly applied and use a “common risk approach.”

The Northern Kentucky Heroin Taskforce examines and targets efforts to stem the use of heroin in much the same way. Kentucky currently ranks 3rd nationally in drug overdose deaths and Northern Kentucky is the acknowledged “heroin ground zero.” In Northern Kentucky, more babies are being treated for drug withdrawal, more people are showing up in the emergency rooms with opioid overdose, and younger people are dying from overdose. The costs are huge. The state’s price tag for heroin, alcohol, and other drug abuse is estimated to be more than $6 billion annually. This takes into consideration the overall burden of heroin: crime, medical care (e.g. overdose, Hepatitis C, addicted babies, and endocarditis), workplace accidents, lost wages due to substance use, and auto accidents.

Suicide is not usually recognized as an endpoint on the “path to death,” a road that is frequently littered with the misery and distress of these antecedent events, but it is. KYLAP is demonstrating leadership to other professional associations by taking care of their own, breaking through the stigma and shame that cloak suicide and its relationship with substance abuse, that frequently cause other professions to look the other way.

While substance abuse prevention is also suicide prevention, we have so much more to do. Targeting efforts in special high risk populations and professions knows for stress and isolation may be critical in reducing this preventable cause of death. Kentucky still needs to adopt more comprehensive policies toward addressing deficits in identifying and treating suicidal people. Whether it is systems of care, such as hospital systems or medical and mental health communities, middle and high school educational systems, systems of higher education and training of future mental health and medical professionals, effective suicide prevention is going to take everyone’s care and attention.

Melinda Moore, Ph.D. is a licensed clinical psychologist and postdoctoral research fellow on the University of Kentucky Military Suicide Bereavement Study. She is also chair of the statewide nonprofit, the Kentucky Suicide Prevention Group, Inc.